Integrating smoking cessation and alcohol use treatment in homeless populations: study protocol for a randomized controlled trial

Abstract

BackgroundDespite progress in reducing cigarette smoking in the general U.S. population, smoking rates, cancer morbidity and related heart disease remain strikingly high among the poor and underserved. Homeless individuals’ cigarette smoking rate remains an alarming 70 % or greater, and this population is generally untreated with smoking cessation interventions. Furthermore, the majority of homeless smokers also abuse alcohol and other drugs, which makes quitting more difficult and magnifies the health consequences of tobacco use.Methods/DesignParticipants will be randomized to one of three groups, including (1) an integrated intensive smoking plus alcohol intervention using cognitive behavioral therapy (CBT), (2) intensive smoking intervention using CBT or (3) usual care (i.e., brief smoking cessation and brief alcohol counseling). All participants will receive 12-week treatment with a nicotine patch plus nicotine gum or lozenge. Counseling will include weekly individual sessions for 3 months, followed by monthly booster group sessions for 3 months. The primary smoking outcome is cotinine-verified 7-day smoking abstinence at follow-up week 52, and the primary alcohol outcome will be breathalyzer-verified 90-day alcohol abstinence at week 52.DiscussionThis study protocol describes the design of the first community-based controlled trial (n = 645) designed to examine the efficacy of integrating alcohol abuse treatment with smoking cessation among homeless smokers. To further address the gap in effectiveness of evidence-based smoking cessation interventions in the homeless population, we are conducting a renewed smoking cessation clinical trial called Power to Quit among smokers experiencing homelessness.Trial registrationClinicalTrials.gov Identifier: NCT01932996. Date of registration: 20 November 2014.

Impact of group motivational interviewing on enhancing treatment engagement for homeless Veterans with nicotine dependence and other substance use disorders: A pilot investigation

“…The homeless population struggles with several treatment engagement issues for smoking cessation, including lack of treatment resources integrating both SUD and smoking cessation treatment and an absence of smoking cessation treatment in most organizations serving the homeless. 41,13 The present study suggests that small and relatively simple tobacco-specific modifications can be easily layered onto existing substance use disorder treatments to enhance engagement in tobacco cessation among homeless Veterans seeking SUD treatment . …”

Interventions to reduce tobacco use in people experiencing homelessness

“…Studies have shown that engaging in smoking cessation does not adversely affect substance use behaviors (Apollonio 2016), and has in-creased the number of days abstinent from alcohol . More recent research efforts such as have focused on designing interventions to reduce smoking initiation among youth experiencing homelessness (Shadel 2014), and to improve quit rates among adults experiencing homelessness (Baggett 2017;Carpenter 2015;Ojo-Fati 2015;Okuyemia 2006b;Okuyemi 2013;Rash 2018).…”

Practical issues regarding implementing a randomized clinical trial in a homeless population: strategies and lessons learned

“…PTQII included (1) a higher dose of pharmacotherapy (nicotine patch combined with nicotine gum or lozenge) and a longer duration of prescribed use (i.e., 12 versus 8 weeks), (2) an increased number of counseling sessions (12 versus 8 sessions over 3 months), (3) an increase in the duration of individual sessions from 15 to 30 min to 45 to 60 min, (4) counseling sessions utilizing cognitive behavioral therapy (CBT) strategies to enable counselors to provide more strategies during counseling sessions, and (5) counseling content targeting alcohol abstinence in addition to smoking cessation. Details regarding the design of this study have been published [ 26 ]. Briefly, the study utilizes a three-group design that includes (1) Usual care (UC) for smoking and alcohol cessation, (2) Intensive smoking cessation plus UC alcohol abstinence counseling (IS), and (3) Integrated Intensive Smoking and Intensive Alcohol Counseling (IntS + A).…”

“…Research staff in both studies received traditional research training that included protecting sensitive information regarding drug and alcohol use, adequate Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Collaborative Institutional Training Initiative (CITI) research training, sexual harassment prevention training, protection of participants reporting sexual harassment and administering unbiased questionnaires [ 25 , 26 ]. It was important to train staff in a variety of additional day-to-day challenges that this population frequently encounters and their relationship to professional boundaries.…”